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R Assadourian

Publications and source records attributed to R Assadourian.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Surgical treatment of hemorrhagic gastritis].

The authors report a review of the literature concerning an observation of rebleeding hemorrhagic gastritis which needed a total hemostasis gastrectomy. 479 interventions are analysed, with all surgical procedures combined. The surgical mortality is 28% and rebleeding reaches 30%. These figures express the evolutive gravity and the difficulty in choosing a treatment for hemorrhagic gastritis. Numerous techniques exist with varying results: the simple gastrotomy with ligations gives 58% rebleeding and 50% mortality. The subtotal Gastrectomy presents a non perfect control of hemorrhage (48% rebleeding, 30% mortality). Among the conservative procedures the choice can be either truncular-vagotomy-pyloroplasty (28% rebleeding, 24% mortality) or vagotomy-resection (18% rebleeding, 34% mortality). All these methods are not perfect and present a rebleeding risk. Only the total gastrectomy provides a definitive cure when the patient can resist the operation. Total gastrectomy was previously considered to be impossible during hemorrhage. However it represents the only way to save patients who continue to bleed following conservative surgery. Total gastrectomy represents a logical technique and should be reconsidered as a second procedure. As first procedure total gastrectomy is debatable. If systematic, it could lead to abusive intervention. If refused, there is a risk of mortal bleeding. Where elderly patients are involved the decision seems to be clear due to the risks of multiple transfusions or second interventions.

Gastrectomy↗
PubMed1988

[Current indications and results of elective truncal portacaval shunt. Apropos of 97 cases].

The authors analyse the results of a series of 97 cases of elective porto-caval anastomoses for ruptured oesophageal varices and compare them with those of the literature. Elective porto-caval anastomosis satisfactorily prevents haemorrhagic recurrence (3%) at the cost of an operative mortality of 10% (nil over the last five years). Porto-caval encephalopathy was observed in 36% of cases with an incapacitating form (stage II or III) in 21% of operated patients and always represented the major disadvantage of surgery. However, the place of truncal porto-caval anastomosis is still intact in the prevention of recurrent haemorrhage from ruptured oesophageal varices. Warren's operation, the reference surgical technique, cannot be performed systematically because of technical reasons and/or because of rigorous selection. Endoscopic sclerotherapy represents a fundamental therapeutic procedure during the haemorrhagic period. Permanent haemostasis is more difficult to obtain and requires surgery in about 25% of cases. The mortality and morbidity associated with the endoscopic method are compared with the surgical results in two series of patients belonging to Child's groups A and B.

Esophageal and Gastric Varices↗
PubMed1981

[Ultrasonic exploration of porto-caval shunts (author's transl)].

Ultrasonography was used to explore surgical porto-caval shunt in 10 patients. In 9 of these, the patency demonstrated by angiography was confirmed, the communication between the two veins being clearly visible on 9 transverse sections, 6 sagittal sections and 2 right frontal sections. In addition, the echograms supplied information on the size of the opening, the calibre of the inferior vena cava (which was usually dilated below the anastomosis) and, in some cases, the presence of thrombosis. Harmless and readily accepted by the patients, ultrasonography is likely to become one of the preferred methods for post-operative control of porto-caval shunts.

Angiography↗
PubMed1980

[Treatment of hydatid cyst of the liver. Our present attitude (author's transl)].

From 1968 to 1978 the authors treated 60 hydatid cysts of the liver. Echotomography and computerised axial tomography showed the topography of the cyst. However, coelio-mesenteric arteriography and cavography are essential before any kystectomy. In spite of its simplicity, resection of the salient dome of the diaphragm is less often used, owing to the risk of bile leakage and recurrence. Pericystectomy fulfils better our therapeutic objectives. It is more difficult to carry out for there is a risk of hemorrhage. Marsupialisation and hepatectomy are exceptional. Since 1974, 13 pericystectomies out of 15 patients have been carried out, whereas resection of the salient dome was previously the most commonly used procedure (40 out of 45 cases). Only regular immunological follow up is a reliable test of lasting cure.

Drainage↗
PubMed1977

[Late ileal metastases from a skin melanoma with mainly hemorrhagic symptoms. Report of one case (author's transl)].

Intestinal metastase from a malignant melanoma are rare and raise difficult diagnostic problems especially when far from the initial tumour. Although acute intussusception is the usual clinical presentation, one should recognise the possibility of atypical symptoms: e.g. repeated digestive hemorrhage or resistant anemia. A sutdy of past history may lead to the discovery of a malanoma. Treatment is unfortunately surgical and palliative to releave the complication.

Gastrointestinal Hemorrhage↗